COMPLIMENTARY COPY - TAKE ONE Medical Marijuana: Kids Voodoo or Consuming Legitimate Fewer Calories Therapeutic Choice?
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Global Health Diet Sodas, as Well as Regular Ones, Raise Diabetes Risk
FEBR U A RY I S S U E - 2013
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Preparing for your Breast Surgical Consultation P13
The findings also support the previously documented association between high intake of regular sugarsweetened beverages and the condition, report Guy Fagherazzi, from the Center for Research in Epidemiology and Population Health, Villejuif, France, and colleagues in a study published online January 30 in the American Journal of Clinical Nutrition.
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The authors also conducted sensitivity analyses to test the hypothesis that people who are at risk for type 2 diabetes by virtue of obesity may preferentially drink artificially sweetened beverages, but the results suggest that such a "reverse causation" mechanism is "unlikely," they note.
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February 2013
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MEDICAL NEWS
A
Diet Sodas, as Well as Regular Ones, Raise Diabetes Risk new study from France suggests that women who drink large amounts of diet soda are at increased risk for type 2 diabetes. The findings also support the previously documented association between high intake of regular sugar-sweetened beverages and the condition, report Guy Fagherazzi, from the Center for Research in Epidemiology and Population Health, Villejuif, France, and colleagues in a study published online January 30 in the American Journal of Clinical Nutrition. Prior research into the relationship between diet soda (artificially sweetened beverages) and type 2 diabetes has produced conflicting results, and while the current study does not necessarily imply causation, there are some biologically plausible mechanisms, the researchers suggest.
And given that diet sodas are "considered — and marketed — as healthier than sugarsweetened beverages," the findings require further investigation, they say. In the meantime, the authors advise that "a precautionary principle could be applied to the promotion of [artificially sweetened beverages]."
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index [BMI]).
Strong positive trends in type 2 diabetes risk were observed across quartiles of consumption for both types of beverage (P = .0088 and P < .0001, respectively). Adjustment for BMI did modify the results somewhat, although the associations remained significant for both sugar-sweetened beverages and artificially sweetened beverages.
Highest Intake of Diet Soda More Than Doubles Diabetes Risk
The data come from a large prospective cohort study of 66,118 women in France investigating links between diet and cancer. There were 1369 new cases of type 2 diabetes diagnosed during the follow-up period from 1993 to 2007.
Based on self-reported dietary consumption, the average intake of regular sodas was 328
mL/week, while for diet sodas it was higher, at 568 mL/week.
The risk for type 2 diabetes was elevated among the women in the highest quartiles for both sugar-sweetened beverages (>359 mL/week) and artificially sweetened beverages (>603 mL/week) compared with women who did not consume those beverages, with hazard ratios of 1.34 and 2.21, respectively, after multivariate adjustment for a variety of covariates (other than body mass
The authors also conducted sensitivity analyses to test the hypothesis that people who are at risk for type 2 diabetes by virtue of obesity may preferentially drink artificially sweetened beverages, but the results suggest that such a "reverse causation" mechanism is "unlikely," they note. "Our results — in accordance with a recent joint scientific statement of the AHA and ADA — strongly suggest the need to conduct randomized trials that evaluate metabolic consequences of [artificially sweetened beverage] components, such as artificial sweeteners, to prove a causal link between [artificially sweetened beverage] consumption and type 2 diabetes," the study authors conclude.
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CONTRIBUTING ARTICLES U.S. Department of Health and Human Services, ARA Content, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features © SEA PUBLICATIONS, INC. ALL RIGHTS RESERVED.
Global Health Tribune is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2013, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.
Adults cut back fast food, but U.S. kids still eat too much fat: CDC
A
merican adults have made a little progress in recent years in cutting back on calories from fast food, but children are still consuming too much fat, U.S. health researchers say.
French fries, pizza and similar items accounted for about 11 percent of U.S. adults' caloric intake from 2007 to 2010, on average, down from about 13 percent between 2003 and 2006, the Centers for Disease Control and Prevention said in one of two reports released.
Younger adults, black Americans and those who are already obese consumed the highest amounts of such food, which is often high in fat, salt and calories that can doom waistlines.
The CDC found in a separate report that while American children, on average, are consuming fewer calories overall than they used to, the percentage of their calories from arteryclogging saturated fat was still above optimal levels.
For example, a 5-foot, 6-inch (1.7 meter) woman weighing 186 pounds (84 kilograms) would be considered obese as would a 6foot (1.8 meter) man weighing 221 pounds (100 kilograms).
Recommended U.S. guidelines suggest that no more than 10 percent of one's daily calories should come from such fat, but American youth took in between 11 percent and 12 percent from 2009 to 2010, data from the CDC's National Center for Health Statistics showed.
Americans' diets and weight is a source of constant scrutiny and research in a country where twothirds of the population is considered overweight or obese. According to the CDC, 36 percent of U.S. adults, or 78 million, and 17 percent of youth, or 12.5 million, are obese. Another third are overweight.
The slight decline in fast food consumption among adults reflects a growing trend toward healthier options. Many food and beverage companies have revamped their products or created new, healthier options to account for the shift in consumer tastes.
Still, Americans lead the world in calorie consumption. Portion
The CDC also said that American boys aged 2 to 19 took in about 2,100 calories daily during 2009 and 2010, a drop from 2,258 calories in 19992000. Girls saw their daily caloric intake fall to 1,755 from 1,831 during the same timeframe.
sizes also have increased over the years, coupled with an increasingly sedentary lifestyle, have added up to extra pounds. Complications from obesity include diabetes, heart disease, arthritis and some cancers.
"Previous studies have reported that more frequent fast-food consumption is associated with higher energy and fat intake and lower intake of healthful nutrients," CDC wrote.
Young black adults are especially a concern. Those aged 20 to 39 get more than one-fifth, or 21 percent, of their calories from fast food versus whites and Hispanics in the same age group who get about 15 percent from such foods, CDC found. Obese and overweight adults also ate more fast food, it added. Healthy weight is calculated by measuring body mass index, or BMI, using height and weight.
It is not yet clear how the recent change has affected childhood obesity rates, the agency added. Among the other findings: * The consumption of calories from fast food "significantly decreased" with age;
* Fast food consumption was about the same for low-income and higher-income adults; * More children are eating more protein, except for black girls; * Carbohydrate consumption is lower among white boys and girls as well as black boys.
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February 2013
Page 3
THE FORGOTTEN FOOT
This little piggy went to market…
Skin-Care Basics for Your New Baby
Bathing a baby and caring for the newborn's skin can intimidate new parents, an expert says.
Newborns are small, vulnerable and slippery when wet, and finding products marketed for their delicate skin can be a challenge, too, said Dr. Dawn Davis, a pediatric dermatologist at the Mayo Clinic Children's Center in Rochester, Minn.
By Arthur Hansen DPM, M.S.
Take a good look at your toes. Are they not as cute as they used to be? Do a couple of them look more like claws or mallets? Some of them may even have corns, calluses or sores on them.
If so, you probably have a deformity called hammertoes. Your toes may look odd to you, but don't fret too much. Hammertoes are relatively easy to treat with no rush to surgery to straighten them; unless they are painful and won't fit into shoes.
There is a tendency toward a genetic disposition of hammertoes. For example, you may have inherited an unusually long second toe whose tip is continually squeezed into a bent position. However, most are caused by an uneven balance of tendons that pull on the toe with eventual bending. Also, a tight tendon can prevent a toe from resting flat and a hammertoe begins to form. Or a bunion on the big toe may crowd the second toe into a bent position. Muscle weakness or arthritis can also cause toes to contract into the hammer position. Ill fitting shoes commonly lead to deformed toes, as well as many other foot problems. A short, shallow shoe forces a toe to bend at the
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joints and bear weight on its tip. After a time, the tendons contract and the toe stiffens into this unnatural position permanently.
Although some people are born with a hereditary contracture and some acquire a contracture from having a systemic disease such as arthritis. Hammertoes are painful with shoe gear often times making daily standing, walking, and working very difficult. Sometimes the pressure on the bent toes can lead to ulcers and infections if left untreated.
Most hammertoes respond to conservative care but surgery is sometimes required for this condition. A surgeon can lengthen the tendon and remove any bone aggravating the condition. Eliminating the contracture of the tendons on the top of the foot strengthens the movement of the hammertoe so it can uncurl and straighten.
and a toe-stretching device is worn at night. Temporary relief can be achieved by lightly taping the protruding toe to hold it down, straight and even with the other toes. Tape is then used to create a sling for pulling the offending digit back into a normal alignment. NSAIDS and/or cortisone injections may be indicated as well.
If you do suffer from hammertoes, see your podiatrist today. He/She can get you back to feeling pain-free and maybe even get those little piggies to do what they are supposed to. Call to make your appointment
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Conservative care of a hammertoe involves exercise and mechanical stretching. The wearing of splints can also be tried. The splint is worn during the day
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Writing in the January issue of the International Journal of Dermatology, Davis offered some advice for making bath time an enjoyable experience and for keeping a newborn's skin clean and healthy.
Newborns are ready for their first bath about six hours after birth. A daily bath for a newborn is not recommended; a bath every other day is sufficient to keep their skin clean. When it is not a bath day, it's safe to gently wipe the newborn's face and skin with a damp washcloth. It's also recommended to wipe the exterior of each eyelid from the inside to the outside corner, Davis said in a Mayo news release.
When giving a bath, it's best to immerse a newborn's entire body into a tub of water, excluding the head and neck. This helps them retain their heat during the bath. Be sure to support the baby while immersed and only a few inches of warm water is necessary for the bath, Davis advised. To prevent scalding, set the water heater thermostat to below 120 degrees Fahrenheit.
Newborn skin is susceptible to irritation and infection, so washing newborns with plain water is a good idea. If you do use products, select mild, neutral-pH cleansers without dyes or fragrances. Use products sparingly and rinse them off completely.
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Page 4
February 2013
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HEALTHCARE NEWS
What is Spirometry Testing? how fast the majority of air in lungs can be expelled at various times in the process. What exactly does this tell the physician and how is it used to treat the patient?
Sheryl Gilman has been practicing respiratory care for 14 years in Palm Beach County. For the last 5 years she has been the Clinical Supervisor of the Cardiopulmonary Department at Lakeside Medical Center, the hospital in Belle Glade serving the residents of the Western Communities. She has specialty certifications in Neonatal and Pediatric care, Pulmonary Function Testing, and is a Certified Tobacco Cessation Specialist as well as having a Bachelor degree in Health Care Services Management.
M
any physiciansâ&#x20AC;&#x2122; offices are now using a small machine to diagnose and begin treatment of lung disease such as asthma or COPD before a full pulmonary function test is even scheduled. This small machine is called a spirometer. It measures the volume of air one can exhale in six seconds and
First of all, this test should not be done on those who are acutely ill such as with fever or flu. Also, if one has recently smoked, this will hinder the ability to blow out effectively. Recent cataract surgery also is an absolute contraindication, so be sure to let the physician know if this applies to you. The spirometry test is totally effort-dependent on the part of the patient. It is extremely important that the patient gives a 100% effort each time as the physician uses the results of this diagnostic procedure to begin treatment for suspected lung disease like asthma or COPD.
Spirometry will tell the physician several things based on whether the patientâ&#x20AC;&#x2122;s results are normal, less than normal or greater than normal. If the results are within normal limits, chances are very good that no airway obstruction is present and all is well with the patientâ&#x20AC;&#x2122;s lungs. Results that are more or less than predicted normal values indicate the presence of a restrictive disease such as pulmonary fibrosis or obstructive disease such as asthma or COPD. Restrictive
Patient takes a deep breath and blows as hard as possible into tube Clip on noise
Breast Cancer Research Needs More Focus on Environment: Report
Technician monitors and encourages patient during test
Efforts to prevent breast cancer need to focus more aggressively and coherently on environmental factors.
That's the conclusion of a new report released Tuesday by a committee tasked in 2008 by the U.S. Congress to investigate the environment's impact on breast cancer.
Chemical and radiation exposure, drugs and consumer products are among environmental factors addressed in the report, but so are less obvious factors connected to lifestyle and socioeconomic resources.
problems can be caused by drugs used in chemotherapy and heart disease, radiation therapy, constant inhaling of dust or other toxins such as seen in mechanics and firemen. Often tumors or pleural effusions (fluid outside the lungs but still in the chest) can be detected. Obstructed problems can be caused by asthma, COPD (largely caused by smoking), or excessive mucous in the airways. Based on the results of the spirometry testing, the physician may refer the patient for further more complete testing and
Machine records the results of the spirometry test
diagnostic procedures. Again, this is why it is extremely important for the patient to give their best during testing. If the patient shows an obstructive process occurring, the physician most likely will start the patient on inhaled medications to improve lung function or medications to thin and decrease mucous. Before office spirometry, patients sometimes had to wait weeks before starting on medications that would greatly increase their quality of life. So if the physician wants you to blow into a strange little machine---give it your all!
If researchers could identify specific factors in the environment, they could take steps to remove them from the environment and/or help people avoid them, said Michael Gould, a member of the Interagency Breast Cancer and Environmental Research Coordinating Committee, which prepared the report.
"This area of primary prevention and taking things out of the environment that might reduce the amount of breast cancer is not as bold as it could be," Gould said.
Environment in this case is defined broadly to mean not just chemicals but also obesity and socioeconomic status, he added. Primary prevention refers to preventing the first onset of a disease, as opposed to a recurrence.
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February 2013
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DEVELOPMENT
Delray Medical Center Proudly Announces Jeffrey Lefton as Director of Behavioral Health Services at Fair Oaks Delray Beach FL – Delray Medical Center is proud to announce Jeffrey Lefton as the new Director of Behavioral Health Services at Fair Oaks Pavilion. In his new role, Lefton will be responsible for the planning, implementation and evaluation of psychiatric treatment programs. In addition, Lefton will ensure that Fair Oaks Pavilion adheres to local, state and federal regulations while overseeing all staff operations.
“Jeffrey Lefton is a great addition to the Delray Medical Center family,” states Mark Bryan, chief executive officer. “I am confident that he will
The Time is Now...
By Bob Wolff
It’s been reported that Palm Beach County leads the country in home demand, and prices have increased a whopping 35%. Yes, Palm Beach is the place again and as I previously reported, inventory, homes that are listed and available for sale, has decreased dramatically. It’s the old story of supply and demand. The demand increases because the supply decreases, and the higher the demand, prices are forced up. It’s logical, isn’t it? If a home is priced correctly, and there are now 10 buyers for each home, as opposed to one, people fight for the home, and prices increase.
Jeffrey Lefton.
continue to ensure that the caring professionals at Fair Oaks work in harmony to help improve quality of life for those with acute or chronic psychiatric disorders, addictions, or other conditions requiring therapeutic intervention.”
T
Lefton also helped spearhead the Crisis Intervention Team (CIT) Training program for law enforcement officers in Palm Beach County and has remained a guiding force in its implementation and growth. As well as being involved in CIT locally, Lefton is a founding member of the Florida CIT Coalition and is a founding
member and current member of the Board of Directors for CIT International, Inc. Lefton also provides training on the Baker Act, Marchman Act, Psychiatric disorders and available treatments, and crisis intervention strategies.
In 2008, Lefton earned his Ph.D. in Health Administration from Warren National University in Cheyenne, Wyoming. In that same year, he graduated from the Law Enforcement Academy and became a Deputy Sheriff with the Palm Beach County Sheriff’s Office, where he continues to work in the Behavioral Services Unit.
Switching Kids Away From Violent TV May Lower Aggression
wo studies, one from the United States and the other from New Zealand, add more fuel to the long-standing claim that exposure to television -especially violent TV -- can harm children. The studies aren't definitive, however, and each offers a different view of TV's impact on kids.
The New Zealand study, for example, looked at a group of children who grew up to have a high rate of criminal convictions and found those who watched the most TV had the most problems. In the American study, however, preschool children randomly assigned to watch
children watch a lot of violent TV and then misbehave or become violent, it could be because they're naturally drawn to that kind of programming and not directly influenced by it, experts say. Or something else, such as parenting or genetics, could explain things.
educational and "pro-social" shows appeared later to be better behaved than kids who watched regular programming. "It's not just the bad behaviors that they get from TV. They can get good behaviors, too," said the U.S. study's lead author, Dr.
Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children's Research Institute. For a variety of reasons, researchers have had a hard time figuring out whether TV is actually harmful to kids. If
The New Zealand study tracked 1,037 children into adulthood (age 26) to see what happened to them. They were born in 1972 and 1973 in Dunedin on New Zealand's South Island.
The investigators found that those who watched the most TV when they were between the ages of 5 and 15 grew up more likely to have a criminal conviction or have an antisocial personality disorder.
Inventory is low! Mortgage rates are low! Rents are high! It's time to act!
Are there a large number of short sales as well as foreclosures, absolutely. This phenomenon, this current housing market, will be in this state for quite some time. We have years of short sales and foreclosures ahead of us. Eventually, these too will be off the market, sold, and we will return to a normal market.
But now is the time to buy as prices increase. I recommend highly that if you do find a home you love, don’t wait. Because if you, there’s a line waiting to buy that home. Love your home, but don’t spend too much time weighing the pros and cons. If you do, call us and start your search anew.
Prior to joining Delray Medical Center, Lefton was employed at South County Mental Health Center for 29 years. He held several supervisory and management positions including the role of Chief Operating Officer. Over the years, he has had a significant role in the development of many innovative programs such as the county’s first and only Children’s Crisis Stabilization Unit, a 20 bed Short-term Residential Treatment
(SRT) Facility, Mobile Crisis Teams, the State’s first Assertive Community Treatment Team, an In-School Suspension Program, the expansion of Crisis Stabilization Unit beds and a county-wide hospital Baker Act diversion system.
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February 2013
Page 7
MEDICINE
Medical Marijuana: Voodoo or Legitimate Therapeutic Choice?
I
magine a 68-year-old woman with advanced breast cancer, looking for a better way to ease her chronic pain, low appetite, fatigue and nausea. Should she or shouldn't she be prescribed marijuana? That's the question physicians debate in the "Clinical Decisions" section of the New England Journal of Medicine released online Feb. 20.
According to the hypothetical case study in the journal, a woman named Marilyn has metastatic breast cancer that has spread to her lungs and spine. She's taking chemotherapy and two anti-nausea drugs that just aren't working. Despite taking 1,000 milligrams (mg) of acetaminophen, such as Tylenol, every eight hours, she's in pain. At night, she sometimes takes 5 to 10 mg of oxycodone, a narcotic pain reliever similar to morphine, to help relieve the pain so she can sleep. Marilyn lives in a state where marijuana is legal for personal medicinal use, and her family stands ready to grow it for her. Why not let Marilyn try it?
One reason not to, in the view of one of the "con" argument's authors, Dr. Robert DuPont, is that it probably wouldn't help her. "Although marijuana probably involves little risk in this context, it is also unlikely to provide much benefit," said DuPont, a clinical professor of psychiatry at Georgetown Medical School in Washington, D.C., and the first director of the National Institute on Drug Abuse under Presidents Nixon, Ford and Carter.
Marijuana is a dry, shredded mix of flowers, stems, seeds and leaves of the hemp plant Cannabis sativa. People usually smoke it as a cigarette or in a pipe. It's the most commonly abused illegal drug in the United States, according to the U.S. National Library of Medicine.
In an interview, DuPont said that because smoked marijuana has not been reviewed and approved by the U.S. Food and Drug Administration for safety, effectiveness and purity, it would be inappropriate for a physician to prescribe it. "It would divert the attention away from an effective medical treatment and get her into something that's at best voodoo," he said.
DuPont argued that with the oral cannabinoids, the precise dosages have been established and the medications take effect more gradually than does smoked marijuana, and thus would be less likely to cause anxiety or panic.
The cannabis (marijuana) plant contains hundreds of pharmacologically active compounds that could interact with the medications Marilyn's now taking, DuPont said. It's impossible to know the chemical make-up or potency of a given dose, he noted, adding, "Medical marijuana has no dose. There is nothing else in medicine like that." DuPont said it's also uncertain how Marilyn might react to the experience of smoking marijuana. He said the drug could affect her ability to think effectively. And just the act of smoking, coupled with the
impact of the cancer on her lungs, could reduce her ability to get oxygen to her brain, he added.
Rather than offering Marilyn marijuana that is smoked, DuPont would prefer she be offered drugs that have been shown to be highly effective for treating nausea and vomiting caused by chemotherapy, such as dexamethasone and aprepitant. Should these not work, he said, he would opt for one of two prescription "cannabinoid" pills that are available: dronabinol (Marinol) or nabilone (Cesamet), which are both approved by the FDA for the same purpose.
Dr. J. Michael Bostwick wrote the "pro" argument for offering Marilyn marijuana. Bostwick, a professor in the department of psychiatry and psychology at the Mayo Clinic College of Medicine, in Rochester, Minn., said he told the editors at the New England Journal of Medicine that he could have made the case for either side. He had a family member with substance-abuse issues involving marijuana. "I kept hearing marijuana is harmless and doesn't cause any problems, and yet I was seeing addiction," he said. Bostwick argues that Marilyn's situation is a clear case for the need to apply clinical judgment: "In the context of an ongoing relationship, as one more treatment in a wide pharmacopeia, it's up to the doctor," he said.
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Page 9
ONCOLOGY NEWS
The Benefits of CyberKnife Treatment for Prostate Cancer
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by Mark Perman, MD
id you know that you can have one of the most effective treatments for prostate cancer right in a doctor’s office? Yes, that’s correct, and it is painless, bloodless, and requires no anesthesia. The treatment is with the CyberKnife, a noninvasive instrument originally devised by a Stanford neurosurgeon to eradicate brain tumors. That same technology has also proven to be highly successful in treating tumors in all parts of the body, particularly the prostate. How does CyberKnife work?
Mark Perman, MD
Board-Certified Radiation Oncologist
Rather than by cutting or burning, the CyberKnife harnesses multiple, focused pinpoint beams of radiation directed precisely upon the prostate. In fact, the technology is so advanced, that it is reliable down to the diameter of a hair. With such an accurate delivery of radiation, doctors and physicists are able to safely concentrate the cancer killing power of a traditional course of radiation from 40 to 45 daily fractions down to five days, delivered in one and ½ weeks. They found that delivering large doses of radiation over a short course of therapy (a technique known as hypofractionation) is beneficial
because prostate cancer cells reproduce slowly, making them more sensitive to higher doses of radiation per fraction. Equally impressive, because CyberKnife prostate treatment limits radiation exposure to surrounding organs, the rate of side effects is very low. Unlike surgery, CyberKnife prostate treatment requires minimal recovery time and men often are able to carry on their normal daily activities such as playing
golf or work during and after the treatments.
Who is a candidate for prostate treatment with the CyberKnife? Generally, men with early stage, localized disease that do not have evidence of aggressive cancer on biopsy, physical examination or a high PSA, can be considered. Men who are considered at high risk for lymph node involvement, very large tumors, very high PSA or those that have spread of the
Help for Chemotherapy induced Neuropathy day, in powdered form, is the most effective dosage of glutamine. Patients who took oral glutamine in this dosage reported fewer symptoms of peripheral neuropathy. Nerve conduction studies did not support this outcome; the symptoms were described by patient self-report.
M
Cindy Collins, Ph.D., R.D.
Experimental Health Psychology / Nutrition
any cancer patients who undergo chemotherapy treatment complain of pain, numbness (dysesthesiasis), burning, or a prickling and tingling sensation (paresthesias) in their extremities. It is commonly reported by 30-40% of patients and may be accompanied by loss of motor function, diminished reflexes and other functional impairment that interferes with quality of life. The condition is referred to as chemotherapy-induced peripheral neuropathy, or CIPN, because it affects the peripheral nervous system; you feel it in the periphery of your body. Sometimes CIPN is experienced as an inability to perform simple tasks such as buttoning, holding a coffee cup, or managing a pen or pencil.
The amino acid glutamine has been studied for its use in preventing CIPN. Glutamine is the most abundant circulating amino acid in our bodies. Amino acids make up proteins and many of them, like glutamine are stored in our liver and our muscle. Glutamine stores can become depleted with cancer. Because glutamine is especially needed in rapidly dividing cells, it was once thought that it might help cancer cells grow. However, the research has shown that glutamine instead decreases tumor growth, may even make the tumor cells more sensitive to the chemotherapy, and upregulates the immune system.
CIPN varies by the chemotherapy agent used during treatment and depending on the way it affects the individual patient. It may come on very quickly, within hours of treatment, or some weeks or months after treatment, with some cases peaking after
treatment is completed. It appears that some symptoms resolve and others are irreversible. Occasionally radiation therapy can contribute to the symptoms CIPN.
If symptoms of CIPN become more severe after treatment, patients should be screened for diabetes, Vitamin B12 deficiency, hypothyroidism and paraproteinemias.
A recent review of the research has produced the following conclusion for ingestion of oral glutamine in the prevention of neuropathy. Thirty grams per
Larger well-controlled studies are required to confirm the selfreport of patients. There are two studies currently being conducted, one with breast cancer patients taking paclitaxel and the other with metastatic colorectal patients taking oxaliplatin. You can read about these studies at the NIH Clinical Trials website. http://clinicaltrials.gov
Patients who have high ammonia levels or hepatic encephalopathy should refrain from glutamine supplementation. All patients should ask your doctor and oncology dietitian before proceeding. For further reading: Oncology Nutrition Connection Vol 20, No. 4, p 3-9.
For more Nutrition Tips for Cancer Patients, read our blog at www.sfrollc.com/blog. South Florida Radiation Oncology (SFRO) is one of Florida’s leading radiation oncology centers throughout Palm Beach County, the Treasure Coast and Miami Dade County. SFRO is committed to personalized, compassionate cancer care through early detection, diagnosis and advanced cancer treatment options. SFRO has offices in 13 locations throughout South Florida from Miami Dade to Port St. Lucie utilizing the latest cancer treatment technologies including TrueBeam, CyberKnife, and RapidArc.
cancer to other organs are not good candidates for CyberKnife. Sometimes some of these more aggressive cases can be treated with a combination of external radiation and Cyberknife. To see if you are a candidate for CyberKnife, schedule a consultation with one of our highly experienced radiation oncologists at South Florida Radiation Oncology. www.sfrollc.com or call 1-877-930-7376.
Alcohol Blamed for 1 in Every 30 Cancer Deaths: Study
For anyone who still thinks that drinking does not contribute to cancer, a new report finds that alcohol is to blame for one in every 30 cancer deaths each year in the United States.
The connection is even more pronounced with breast cancer, with 15 percent of those deaths related to alcohol consumption, the researchers added. And don't think that drinking in moderation will help, because 30 percent of all alcohol-related cancer deaths are linked to drinking 1.5 drinks or less a day, the report found.
Alcohol is a cancer-causing agent that's in "plain sight," but people just don't see it, said study author Dr. David Nelson, director of the Cancer Prevention Fellowship Program at the U.S. National Cancer Institute.
Moderate drinking has been associated with heart benefits, Nelson noted. "But, in the broader context of all the issues and all the problems that alcohol is related to, alcohol causes 10 times as many deaths as it prevents," he said.
The best thing people who believe they are at risk for cancer can do is reduce their alcohol consumption, Nelson said. "From a cancer prevention perspective, the less you drink, the lower your risk of an alcohol-related cancer and, obviously, if one doesn't drink at all then that's the lowest risk," he said.
The report was published online Feb. 14 in the American Journal of Public Health.
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February 2013
HEALTH & WELLNESS
F
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Kids Consuming Fewer Calories inally, some good news in the war on childhood obesity: Kids in the United States now consume fewer calories each day than they did 12 years ago, according to a new government report.
Even better, between 1999 and 2010, most boys and girls between 2 and 19 years old began getting more of their daily calories from muscle-building proteins and fewer from carbohydrates, which can easily spur weight gain when eaten to excess, the U.S. Centers for Disease Control and Prevention report found. The findings, based on dietary data obtained from the National
healthy body weight may finally be getting to its intended audience," Solomon said. "Hopefully if we teach children the importance of appropriate calorie intake and nutrient balance, we will reverse the obesity problem over the next several decades." Health and Nutrition Examination Survey, suggest a step in the right direction for a nation where 17 percent of all children and adolescents are obese. Excess weight in childhood is linked to a host of health problems later in life, including heart disease and diabetes.
"This certainly reflects an improvement in food and drinkrelated decisions," said Rebecca Solomon, coordinator of clinical nutrition at Mount Sinai Medical Center in New York City. "It would seem that education and public awareness about the importance of maintaining a
When people eat more than they need to fuel their everyday activities, the body stores the extra calories as fat cells for use later. Over time, this can lead to weight gain and eventually obesity.
According to the new report, boys' daily calorie consumption on average fell from 2,258 calories in 1999-2000 to about 2,100 on average in 2009-2010. Girls' intake dropped from 1,831
calories to 1,755 during that time period.
The survey found some notable racial and ethnic differences in eating patterns, however.
For instance, the percentage of daily calories derived from protein -- think of beans, nuts and meat -- rose from 13.5 percent to 14.7 percent among boys and from 13.4 percent to 14.3 percent for girls during the 12-year period. However, protein consumption for black girls stayed around 13.5 percent.
Carbohydrate consumption -carbs are found in breads, potatoes and pasta -- decreased among boys, from 55 percent in the earlier time period to 54.3 percent in 2009-2010. For girls, carbohydrates dropped from 55.8 percent of their total calories eaten to 54.5 percent. These declines in carbohydrates were not seen among black girls and Mexican-American girls, however. Experts hailed the findings and credited wide-ranging efforts from the White House to schools and altered decision-making by parents.
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YOU Y OU WILL ENJOY ENJO ENJOY: Y: • TTour our ooff the facility facility O Dietitian and Nur se PPractitioner ractitioner • A meet and gr greet eet with SFR SFRO Nurse • LLearning esources: earning about classes and rresources: o Cooking o Counseling o Juicing o Massage o Meditation o Resources Resources ffor or hair loss Groups o Support Groups o Tai Tai Chi • Community involvement with local vendor vendorss *Refreshments *R efreshments and healthy ffood ood samples will be available.
Our mission is to dedicat dedicatee ourselves ourselves to our patients in their journey Wee recognize journe y from from cancer diagnosis to survivorship. W recognize the importance caree of the whole person and want import ance of taking taking car and w ant patients healthy, Wee will be yyour lifeline! to live live health y, cancer-free cancer-free lives. lives. W our lif eline!
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Sharon Zarabi, a nutritionist / fitness trainer at Lenox Hill Hospital in New York City, believes that Michelle Obama's "Let's Move" campaign may have increased awareness of the obesity epidemic and encouraged children to eat more nutritious foods and boost their activity. "It's promising to see nutrition becoming a priority in schools starting with the banning of soda and sweetened beverages on campus," she added.
Zarabi said she believes the increased availability of low-fat milk, tofu, fruits and vegetables has encouraged children to make better choices at school and "hopefully at home."
Solomon also attributed the decrease in carbohydrate consumption to a better understanding of the empty calories in juice and soda. "It is possible kids are favoring water, seltzer or diet drinks as a response to the bad press about sugary beverages," she said. "In addition, high fructose corn syrup has been vilified over the past several years, and it's possible that parents and children are heeding the warning to reduce this type of sugar, among others." However, Solomon expressed some concern that eating more protein is not necessarily a good thing. The availability of protein bars, soy snacks and Greek yogurt, which has nearly twice the protein, ounce for ounce, as typical yogurt, has likely increased protein intake, she said.
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February 2013
HEALTH & BEAUTY
Page 11
Too Much Coffee in Pregnancy Tied to Smaller, Later Newborns
T
he coffee or other caffeinated beverages a woman drinks during her pregnancy might up the odds for a low birth weight newborn or an extended pregnancy, a new study says.
was extended eight extra hours, the study authors found.
Given this finding, it is likely that it is not only the caffeine, but something else in coffee that is acting to extend pregnancy, the researchers added.
The researchers included data on nearly 60,000 Norwegian women.
"As the risk for having a low birth weight baby was associated with caffeine consumption, pregnant women might be counseled to reduce their caffeine intake during pregnancy as much as possible," said lead researcher Dr. Verena Sengpiel, an obstetrician/gynecologist at the Sahlgrenska Academy of Sahlgrenska University in Goteborg, Sweden.
She believes the findings should also spur a re-evaluation of current recommendations from the American College of Obstetricians and Gynecologists, which advises that a pregnant woman's caffeine intake not exceed two cups of coffee per day. However, because the study was observational in nature, it can't establish a cause-and-effect relationship between caffeine and low birth weight, Sengpiel stressed. "We cannot say from our data whether caffeine is the specific substance responsible
A
Folic Acid in Pregnancy May Lower Autism Risk new study suggests that women who start taking folic acid supplements either before or early in their pregnancy may reduce their child's risk of developing autism.
"The study does not prove that folic acid supplements can prevent childhood autism. But it does provide an indication that folic acid might be preventive," said study lead author Dr. Pal Suren, from the division of epidemiology at the Norwegian Institute of Public Health in Oslo.
"The findings also provide a rationale for further investigations of possible causes, as well as investigations of whether folic acid is associated with a reduced risk of other brain disorders in children," he said.
Taking folic acid supplements during pregnancy is already known to prevent birth defects such as spina bifida, which affects the spine, and anencephaly, which causes part of the brain to be missing.
Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City, said, "Other studies have indicated that caffeine can affect fetal weight, so this is in accord with findings of other studies." Why caffeine might cause this effect is unclear, she said.
for the fetus being at greater risk of [becoming a] low birth weight infant, nor did we study if these babies actually had special health problems during the neonatal period," Sengpiel said. The report was published online Feb. 18 in the journal BMC Medicine.
In the study, Sengpiel's team accounted for all sources of caffeine, including coffee, tea, sodas and food including cocoa (such as is found in desserts and
chocolate), for almost 60,000 pregnancies tracked by the Norwegian Institute of Public Health.
They found that while caffeine was not linked to premature birth, caffeine from all sources was tied to a higher risk for reduced birth weight.
For example, if an infant's weight is expected to be 7 pounds 15 ounces, every 100 milligrams of caffeine consumed by its mother a day reduced a
newborn's weight by almost an ounce, the researchers reported. According to the Mayo Clinic, the average cup of Americanstyle brewed coffee contains between 95 and 200 milligrams (mg) of caffeine.
Moreover, every 100 mg of caffeine consumed per day increased the length of pregnancy by five hours. And when the caffeine came from coffee (as opposed to other sources) the length of pregnancy
"We do know that caffeine crosses the placenta and the baby is not able to metabolize it very well, [so] it may affect some of the factors associated with growth," Wu theorized.
She advised that women limit the amount of caffeine they consume during pregnancy. The World Health Organization says 300 mg a day, but in the United States the recommended amount is 200 mg a day, she added. Wu noted that is the amount of caffeine in two small cups of coffee, not a "Starbucks size coffee." There is less caffeine in a cup of tea, or a piece of chocolate, which has about 35 mg of caffeine, she said.
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February 2013
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PRACTICE TRENDS
LET’S GET PHYSICAL Shekhar V. Sharma, M.D. Board Certified in Internal Medicine
Why is exercise so important to all of us?
muscle fibers that are brought about during exercise, Type 1 and Type 2 muscle fibers.
Well let me tell you, the benefits of exercise are well documented, which include reducing the risk of heart disease, reducing blood sugar levels in diabetics, improving blood pressure, alleviating depression and also improving overall general health and improving one's lifestyle.
Type 1, is also called the slow twitch fibers, which are built for slow but enduring movement because they are able to refuel by taking in oxygen when a person draws a breath.
The next type that comes into play is the fast twitch fibers, which are Type 2. This in turn is used to increase muscle mass and that is done only when one increases resistance and frequency of the muscle beyond which would be normally expected. These fibers also burn energy at a much higher rate. This results in the strength development.
An inactive lifestyle is one of the biggest problems that we face as adults today. One needs to be more selfanalytical and have more self-awareness on a daily basis about the things that we should have done, but have not. By that, I mean daily exercise. So, how much should one exercise on a daily basis?
What is the goal when one exercises?
I would say probably between 30 and 60 minutes should be good. When you exercise, you increase your muscle mass in a healthy way. Avoid taking artificial steroids which could have devastating effects in the long run.
The first is to achieve body mass index of below 25 as you will see in the chart that I included in my previous article. The other goals are to reduce stress depression, reduce the chance of getting diabetes mellitus, hypertension, and of course increase ones sense of well¬-being.
Exercise physiology explains that there are two types of
Reasons for failure to exercise
are numerous. They include fear of injury or pain, no access to exercise facilities, the lack of knowledge of the proper technique and of course, lack of interest. In this case, the practitioner and the patient should work together as a team to promote exercise.
What three types of exercise do we all need to explore?
First is stretching, second is aerobics and third is anaerobic, which is also called resistance exercise. Stretching exercises are good for loosening up your muscles and joints. Aerobic exercise is also called cardio. This type of exercise is good for diseases such as diabetes mellitus. Finally, anaerobic, which are resistance training exercises that are good for preventing osteoporosis. Weight lifting and push-ups are good examples of muscles resistance exercises. Who should not exercise?
I would say those with heart disease. If you’ve had a recent heart attack, have unstable angina or severe aortic stenosis, which is severe valvular heart disease of the opening of the
aorta. You should also avoid exercise if you have severely uncontrolled diabetes mellitus and uncontrolled hypertension.
I would strongly encourage my patients or anyone else to get medical clearance before undergoing an exercise program. In addition to exercise, you need
to create a healthier lifestyle by eliminating fast foods, soda and eating late at night, thereby improving ones waistline. I had addressed what the waistline in the male and female should be in my previous article. I have to admit, I personally exercise every day and I feel great afterward.
PALM BEACH PRIMARY CARE ASSOCIATES, INC. Dr. Sharma is a Board certified Internist. His office is accepting new patients: Palomino Park, 3347 State Road 7 Suite 200, Wellington, FL 33449 and for an appointment please call
(561) 795-9087
Dr. Sharma's office in Belle Glade is at 1200 South Main Street, Suite 100 (opposite the Old Glades General Hospital). He will be seeing patients at this location along with Ebonee Johnson ARNP. He is currently accepting New Patients and the office accepts most insurances. We accept Florida Medicaid Call
561-996-7742 for an appointment.
PALM BEACH PRIMARY CARE ASSOCIATES, INC. State of the Art Office Building with Imaging Center,
Shekhar Sharma M.D. Ebonee Johnson A.R.N.P.
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MEDICARE, BLUE CROSS BLUE SHIELD, UNITED HEALTH CARE, AETNA, CIGNA, HEALTH CARE DISTRICT AND MOST MAJOR INSURANCES ACCEPTED On staff at Palms West Hospital and Wellington Regional Medical Center
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February 2013
WOMEN’S HEALTHCARE
Preparing for your Breast Surgical Consultation
I
Dr. Yvette LaClaustra.
By Deborah Lynn
n continuing our series with Dr. Yvette LaClaustra, we would like to explore what takes place during your surgical consultation. According to Dr. LaClaustra, “some patients that come through my door have no idea why they are seeing me. It’s a scary notion when your primary care physician, internist, gynecologist or nurse practitioner suddenly requests that you schedule a consultation with a surgical specialist. Their initial thought would be, I must have cancer and they’re scared.” Fortunately, approximately 70% of the patients that visit with Dr. LaClaustra do not have cancer. Instead, they generally have a benign cysts, or fibrocystic breasts.
Fibrocystic breasts is a condition in which the tissue of the breast
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feels lumpy or tender. This condition is commonly referred to as nodular or glandular breast tissue. As this is relatively common, at least half the female population has experienced this type of condition at one point or another. Although benign, it can be quite painful and tender, especially prior to your menstrual cycle.
“We have learned that this condition generally affects women with dense breast tissue who are often very sensitive to hormonal changes. Women with fibrocystic breasts will be at a slightly higher risk for breast cancer. This may be related to the hormones that affect the breast tissue.
When a patient comes to see me, they should have already had a good breast examination by their primary care physician, a mammogram and if the breast tissue is dense or they’re younger, they should have an ultrasound taken prior to their surgical consultation. The films will ideally be of a digital mammogram. I will then perform a breast exam, look at the mammogram and review their history. Your family history will also include your grandparents. How did your grandmother die? Did she have cancer? If so, what type? All of these factors play a role in
T
Drug, Alcohol Abuse More Likely Among High School Dropouts he link between poor academic performance and substance abuse just got stronger, with a new U.S. government report showing ties between the two.
High school seniors who dropped out of school before graduating were more likely to drink, smoke cigarettes and use marijuana and other illegal drugs, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration.
making a proper diagnosis or assessment” stated Dr. LaClaustra.
Today there is a new technology called, digital breast tomosynthesis (DBT), which creates a three dimensional (3-D) image of the breast using x-rays. It allows the breast to be viewed in multiple x-ray pictures from a variety of angles. Although the breast will still have to be positioned, there is a minimal amount of pressure and therefore, far less uncomfortable than a mammogram. Following her assessment, Dr. LaClaustra may schedule further
testing, such as a biopsy of the tissue. More often than not, patients will simply need to be educated on their condition.
Dr. LaClaustra is an extremely caring and compassionate physician that not only has her patients' well-being and best interest at heart, but is intent on making sure their experience is as positive and educational as possible.
If you would like to make an appointment with Dr. LaClaustra, you can reach her Wellington office at 561-965-1100. Or, visit her website at www.womensbreastcarecenter.com
The researchers said their findings should prompt communities to develop strategies to keep teens in school and prevent problems with substance abuse.
"The fact that nearly one in seven students drops out of high school has enormous public health implications for our nation," SAMHSA Administrator Pamela Hyde said in an agency news release. "Dropouts are at increased risk of substance abuse, which is particularly troubling given that they are also at greater risk of poverty, not having health insurance, and other health problems. We have to do everything we can to keep youth in school so they can go on to lead healthy, productive lives, free from substance abuse."
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February 2013
COMMUNITY EVENTS
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It’s all about the Survivors during the Race for the Cure T he Komen Race for the Cure isn’t necessarily about the race anymore, but recognizing the survivors. It’s about getting together to celebrate life and their struggle to maintain it while raising money to support such a worthy cause. The event was packed, especially around the sponsors booths,
which gave away special trinkets as a memento of why everyone was there. Everyone had a story of someone special that is battling the disease or sadly had succumbed to their illness. Through all of the pain that those have or are experiencing, it’s all about the love, hope and inspiration that each and every person carries within themselves.
DEAR DEBORAH: Since men and women are inherently different, what do you feel are some of the main differences that may have an effect in a relationship? - Are we THAT different?
and try to read between those non-existent lines. In doing so, they get worked up over nothing. Women simply need to stop over-thinking and overanalyzing.
Dear Are we THAT different: There are numerous differences between the two sexes. Let me touch on some that can have an impact in a relationship.
First the obvious, men are logical and women in general run off of their emotions.
Women need to feel wanted. Men want to feel needed.
When men make a statement or comment, it should be taken at face value. Women tend to read more into what men say
Women tend to talk to men as though they are their female friends – they’re not. Instead of long drawn out stories, be concise. If women have a long, detailed and drawn-out story to tell, they should call their girlfriends.
Women love to discuss their relationship issues with their female friends. I personally feel that they should not do this due to the fact that women generally use emotions to help guide them in their decision making. Make your own decisions using logic.
Although not a comparison, I often hear men complain that
women nag or whine too much. Both of which are a turn-off to men.
In my opinion, those are some of the differences that may have an impact on a relationship.
DEAR DEBORAH: I seem to have been dating all the wrong men and decided to try online dating. Thankfully, men have been showing interest, but when I respond, they don’t reciprocate. I look for things in their profiles and let them know that I like those things too, but it doesn’t seem to matter. I am dumbfounded. Therefore, I need to know what I am doing wrong and why they don’t respond back since they initially contacted me. - Talk to ME Dear Talk to ME: Online dating is so common
Dear Deborah
these days and there are many more opportunities for people to meet. Long gone are the days when you were limited to your choices in a partner. Therefore, you need to make yourself stand out among other women. One important thing to remember when you are creating your profile is to be optimistic. Put a positive spin on everything and keep the negativity out.
Regarding your response, when you find something of interest in their profile, how are you responding? Do you simply say, “I see you like baseball, I like it too.” If you are sending someone a message, you need to make your response stand out by using fun and friendly banter. For example, if they mention that they are a baseball fan, you may
want to say, “Did you see the Cubs game last night, I cannot believe they got three runs in the 9th to pull out the win.” You can get the communication started by giving conversation starters. Give your opinion, not facts. Act as though that person is right in front of you and you’re having a conversation.
Please keep in mind, if they are sending you an e-mail, they may be sending one to several others as well. Therefore, do not lose hope when someone does not respond. Good luck to you!
Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to: questions@globalhealthtribune.com as we would love to help.
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UPCOMING EVENTS
Upcoming Charity and Medical Fundraising Events February 20 – March 31, 2013
February 23
South Florida Radiation Oncology (SFRO). Survivorship Clinic open house. 11:00 a.m. to 2:00 p.m. at 3355 Burns Road, Suite 105 in Palm Beach Gardens. For additional information, call 561-775-7748.
Dana-Farber Cancer Institute. 22nd Annual Discovery Celebration, “Phantom of the Opera.” The Mar-a-Lago Club, Palm Beach. For additional information contact Debra Van De Warker at 561-833-2080.
February 28
Israel Cancer Association. USA Annual Gala. The Breakers, Palm Beach. For additional information, contact 561-832-9277 or e-mail jcooper@icausa.org.
March 2
Ryan Licht Sang Bipolar Foundation. Young Friends “Gone Country” Dinner Dance. Bonnette Hunt Club, Palm Beach Gardens. Tickets are $100.00 per person. For additional information, contact www.sixthannualgonecountry.org.
March 3 & 4
Place of Hope. 2013 Golf Invitational and Charity Dinner. Old Palm Golf Club, Palm Beach Gardens. Single player $1,500.00/Foursome is $6,000.00 – sponsorships available. For additional information, call 877-694-HOPE or visit their website at www.placeofhope.com.
March 4
Senior Lifestyle and Healthcare Expo. South County Exhibit Center, Delray Beach. An event for seniors, caregivers and family. Screenings are available onsite. For additional information, call 754-246-2874 or visit their website at www.retirement-times.com.
March 7
Cancer Alliance for Help and Hope (CAHH). City Lights for Life. Palm Beach Motor Cars, West Palm Beach. Tickets are limited at $50.00. For additional information, call 561-748-7227 or visit their website at www.cahh.org.
March 8
Easter Seals. A Pair to Remember. Grand Court, Gardens Mall in Palm Beach Gardens. Tickets are $125.00 or a table of 10 for $1,500.00. For additional information, contact Jamie Walton at 561-471-1688 or visit their website at www.fl.easterseals.com/westpalmbeach.
March 9
Juvenile Diabetes Research Foundation. First Annual Casino Night. Palm Beach Lamborghini Showroom, West Palm Beach. Tickets are $125.00 per person or $200.00 for two. For additional information, contact Anne Noble at 561-686-7701 or e-mail anoble@JDRF.org.
March 16
Unicorn Children's Foundation. Buddha Ball. Mar-a-Lago Club, Palm Beach. Tickets start at $500.00. For additional information, contact Sofia Santiago at 561620-9377 or e-mail sofia@unicornchildrensfoundation.org.
March 21
Red Cross. 3rd Annual Honoring the Hero in All of Us. Ruth’s Chris Steakhouse, Boca Raton. Tickets are $150.00 per person. For additional information, contact Jennifer Durrant at 561-650-9105 or e-mail Jennifer.durrant@redcross.org. Or, visit their website at www.pbtcredcross.org.
February 2013
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